“Jason” had done his research and knew exactly what symptoms would send him straight to the emergency department.

“Faking a head injury, it really gives you an opportunity to ham it up a little bit,” said Jason, a Southern California professional in his 30s who declined to give his name. His ruse got him a CT scan.

Jason is not a hypochondriac, nor does he suffer from Munchausen syndrome, a disorder in which people fake illnesses to elicit attention. Instead, he’s a “mystery shopper,” an undercover consumer hired

by health care providers to feign illness or injury. They do so to evaluate how well hospitals treat patients.

In the case of the phony head injury, Jason kept up his pose until a concerned emergency doctor wanted him to submit to further “potentially painful” tests.

“I had to think on my feet and think, God, do I want to go through this?” he said. “Ultimately, I refused treatment.”

By that time, he had the information he needed.

The practice of mystery shopping is well known in the retail industry. It’s used by department stores, restaurants, hotels and other businesses to fine-tune service and attract customers.

As hospitals and other facilities have come under increasing scrutiny, more health care organizations are turning to mystery shoppers to learn how they can better satisfy patients and improve their reputations.

Devon Hill Associates of San Diego is one of few companies nationwide that specializes in medical mystery shopping.

The firm’s founder and president, Barbara Gerber, regularly poses as a patient and recruits others, like Jason, to surreptitiously observe medical professionals, checking for flaws as well as good practices that could make a patient’s experience more comfortable and improve the quality of medical care.

“Hospitals see the world changing around them and there’s more of (an) emphasis on quality and customer service,” said Gerber, a former hospital administrator who has been conducting mystery patient visits for 10 years. She said demand for her business has increased in the past year or two.

While one can imagine the allure of pretending to be a real customer at, say, a nice restaurant or a golf course, why would someone voluntarily spend hours in a hospital waiting room — let alone submit to unpleasant scans, blood tests and examinations?

Gerber, who has undergone tests that have taken her to the point of being wheeled into the operating room, said her “shoppers” are motivated by wanting to improve health care services. She screens out anyone who appears to have an agenda, such as wanting to retaliate for poor medical treatment.

“When it comes down to simulating an illness and going through an examination, it takes sort of (a) special person,” she said.

Most of the visits are routine and involve basic diagnostic testing, she said. Often, a doctor is “in on” the mystery visit because the point is not to check the medical care per se, but to see how hospital staff members — from the front desk to the pharmacy — interact with the patient.

Devon Hill’s clients are typically hospitals and long-term care facilities. They pay between $10,000 and $40,000 for the firm’s services.

The foundation opted against having fictitious uninsured patients undergo medical treatment, said Maribeth Shannon, director of the foundation’s hospitals and nursing homes program. Shannon said the foundation was concerned about adding unnecessary procedures and bills to an already overburdened health system.

She maintains that hospitals generally can absorb three to five mystery visits without compromising care for others. What’s more, she says her shoppers’ supposed injuries are never severe enough to take priority over patients with serious traumas.

Gerber said “patient” visits are just part of the job. Writing meticulous reports about the experience can be even more time consuming.

“It was very, very interesting to hear from the mystery shopper their perspective of lying in a patient bed and spending the night,” said Zoe Rodriguez, who hired Devon Hill to carry out a series of mystery visits when she worked at Southern New Jersey’s Burdette Tomlin Memorial Hospital.

Rodriguez, who now works as the director of laboratories at Kennedy Health System in Cherry Hill, N.J., said Gerber’s reports were extremely detailed — noting stains on the waiting room furniture, how
staff members dressed and whether they addressed patients by their first names.

Based on the report, the hospital made a number of changes, such as changing the waiting-room system and rescheduling some night-time duties that woke patients up.

“In health care, the consumer is getting very savvy,” Rodriguez said. “Patients have the opportunity and ability today to make informed decisions and select where they want to receive care.”

To gather detailed observations, Gerber’s network of sleuths must find ways to note their impressions without drawing attention. Sometimes that involves covert recordings. While California does not allow tape recording without the consent of all parties, some states require that only one party be aware.

“Everybody who does this gets a little nervous,” Gerber said. “They’re nervous because they have to act. They’re a little bit nervous because they’re afraid someone will pick out who they are and they won’t be able to carry it off.”

Jason, who has a full-time job, conducts mystery visits on his own time. Because hospital workers are not expecting “fake” patients, he doesn’t expect to get caught, he said. He commits his observations to memory, noting that he is good at recalling details. Sometimes he calls his voice mail to leave information.

“Joan,” 64, another mystery shopper, said she take notes in newspapers or crossword puzzles. Sometimes she slips into a restroom to jot down information.

Joan, a resident of a southwestern state, said she and her husband, who are both retired, segued into the medical field after doing mystery shopping at other locations, such as restaurants.

Gerber won’t divulge how much she pays her “shoppers.” Joan said medical visits pay better than other forms of mystery shopping. Still, she isn’t doing it for the money.

“If you break it down for the fact you’re away from home for two or three days and spend two or three days writing reports … you’re probably making 25 cents an hour,” she said.

Joan said she likes playing a role and helping hospitals improve the patient experience. If the hospital is out of state, Joan said she and her husband can enjoy a free trip and hotel stay.

While her husband has undergone blood and imaging tests, Joan said she has not had to endure anything more extensive than an X-ray when she limped into an emergency room in a California hospital.

“In that particular case, one of the things I found was I was left in a room without a lot of explanation about what was going to happen next or when,” she said. “As a patient, that can not only be frustrating and irritating, but, if you’re really sick, that could be frightening.”

Joan is planning her next “visit,” which will be to an out-of-state hospital. She won’t reveal any details. This next job will involve a complex scenario, but Joan isn’t worried.

“We come up with a specific ailment to see how they (hospital staff members) handle it, but we don’t have to have our appendix out,” she said.

Devon Hill Associates is a mystery shopping, marketing and sales training company that focuses on the healthcare and senior living & long-term care industries. We specialize in mystery shopping for hospitals, HMOs, clinics, nursing homes, assisted living and retirement communities nationwide. Devon Hill Associates is located in La Jolla, California. For information on mystery shopping and other services, call 1-858-456-7800.